3 Weeks Post Rhino, One Side is Beginning to Sink?

Swelling of the nose after rhinoplasty is common.  An examination is important to distinguish between swelling and cartilaginous fullness. Surgery90210

You are correct that swelling will be present at 3 weeks after a rhinoplasty.  Swelling in and around the tip last longer than the other areas of the nose.  It is hard to tell without a picture, the cause of the difference between the 2 sides.  I would first look at your pre-op pictures to see the difference of the 2 sides before surgery.  Many times patients are surprised that these asymmetries may of been present before the surgery.  The indented area could be due to uneven resolution of swelling, scar-tissue formation on the non-indented side, or over resection of the support in the area.   

Regardless of the cause, at 3 weeks after surgery, it is best to allow your nose to heal and to evaluate your nose at a later time.  If the asymmetry is present after the healing has resolved, you can then talk with your surgeon to decide the best next step.

 

I hope this helps!

You're right that there should still be swelling in the area this soon after surgery. It's hard to comment without seeing your nose, but it isn't uncommon for the nasal swelling to be somewhat asymmetric at this stage. I would give your nose time to heal and continue following your surgeon's instructions.

After rhinoplasty the swelling typically peaks on Day 3 or 4 following surgery.  It then begins to decrease and will initially decrease fairly quickly then much more gradually over the course of the next 9 to 12 months.  Typically the tip and supratip regions remain swollen for longer time frames than other areas.  I inform my patients that at approximately 2 weeks postop, approximately 75% of the swelling has resolved and by 4 weeks 85% of the swelling has resolved.  The remaining swelling takes much longer to fully resolve. 

Causes for asymmetrical contours that appear in the postop course following rhinoplasty include: 

1.     Asymmetry in the bone-cartilage nasal framework.  When the external splint or cast comes off the nose at 1 week, the swelling is still prominent and will mask any underlying framework irregularities.  As the swelling decreases over the next few weeks, these asymmetries will become apparent.

2.     Adverse healing or scarring in the soft tissue envelope that progresses over time.

3.     An uneven rate of resolution of the swelling during the healing period, particularly if there is a pocket of trapped blood on one side and not the other. 

In general, I have found that irregularities I have left in the bone-cartilage framework as the most common reason for asymmetry that begins to show up a few weeks following surgery and unfortunately, it tends to not disappear with time.  A hands-on examination will help determine what may be the underlying cause of the asymmetry in your particular situation. 

At this point, I would recommend frequent visits with your surgeon in the follow-up period.  If he believes that the asymmetry is based in the soft tissue, it may be advisable to cautiously treat the prominent area with injections of steroid. 

Thank you and good luck, Mario J. Imola, MD, DDS, FRCSC.  

 

After rhinoplasty when the splint is first removed patients can't help but stare and examine their nose constantly for the first few weeks. As a general rule when I first remove the splint from my patients I advise them that over the next two weeks the swelling will may go down unevenly and that one day one side may look bigger and then the next day the other will look different. I advise them not to panic as often this will settle down after the first 4-6 weeks. Check with your doctor about your situation.